HomeMy WebLinkAboutSchembri (3) ,II I®�®of F0iir
ELIZABETH A. NEVILLE ���� ; Town Hall, 53095 Main Road
TOWN CLERK % ® P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS Fax (631) 765-6145
MARRIAGE OFFICER k ` r
RECORDS MANAGEMENT OFFICER "�j% �� lig Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ '` ,s" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2738 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SCHEMBRI HOMES INC
Address 1 : 2042 NORTH COUNTRY ROAD
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0266
Name Of Owner SCHEMBRI HOMES INC
Mailing Address 1 2042 NORTH COUNTRY ROAD
City St Zip WADING RIVER NY 11792
Property Address 1 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 6 lot 8.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/20/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLENo
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Orf7CZ N THE VITIOL.PAIC ~�C�7
TownopsotmtoLD ••'SCJ COGy: Application No. G
t PLUBEINA NEVILLE,TOWN CLERK %7
PO.BOX 1179 :' I Construction L---""
►' SOUTHOLD,NEW YORK 11971 :crn I
15 1 Alteration
Tele hone .%r0 .',N",: • $10.00 -Residential
P
.,(63t) 765-1800 0l 0./ $25.00 -Non-Residential
TOWN OF SOUTHOLD . •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
,iAPPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee•$
DATE
APPLICANT NAME: ) da,,,-...0-
9 \ -, "/n
APPLICANT ADDRESS: O--'61 )4.2 / ^- 61 /��
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCT N OR ALTERATION
•
LOCATION MAP: Must be attached hereto before permit may be Issued.
LOCATION OF PROPOSED CONSTRUCT ON •R ALTE•ATIO
OWNER OF PROPERTY: r ,, /�J_ f� /
OWNER MAILING ADDRESS: p fes"/x`25 �t' OIL"
.,5,1031111MarRILW
OWNER PROPERTY ADDRESS: (AMU"'. � -= a
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TELEPHONE NUMBER OF I ` 0
CONTACT� PERSON:{ 9 '-sY6I
TAX MAP NO.: Sectlo O1( Block 0 Lot Ine
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CROSS STREET: /''j di' i_"r A'_
BUILDING PERMIT NUMBER ROSS REFEREN E:
i ny.l.
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� / Signature of Applicant s
RECEIVED BY: A;L C
Town/clerk's Office
DATE: // .5/ U 'Z •
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